How to Empower Yourself in the Doctor-Patient Relationship
-and Why It's More Important than Ever to Do So

By Dr. Meera Kelley
July 2008

As you get older, your health care needs change. You need more routine tests, more frequent checkups, and more medicines. Consequently, more interaction is required with an increased number of health care professionals. For many, though, even an annual trip to the doctor's office evokes a certain amount of anxiety. But there are some tools you can use to demystify the journey through your medical care and become a confident, proactive partner in the doctor-patient relationship.

Even hospitals are helping to empower patients, recognizing it as a benefit likely to improve outcomes in the continuum of care. At WakeMed Health & Hospitals, for example, a team has been created to foster a culture where the patient is not perceived as a passive recipient of services.

"Ultimately, it is the patient's body," explains Elaine Rohlik, executive director of Rehab Services who leads the team that also strives to improve communication between the patient and medical team. "The patient should expect our support and we should respect and respond if the patient has a question or concern." Immediately upon check-in, WakeMed makes available information on how to voice a concern, the rights of the patient, and what should be expected from the treatment team.

Why the new focus on elevating the role of the patient? The United States health care system has become incredibly complex. In the 1950s, a patient would see one doctor and possibly one nurse for everything from flu medicines to dermatologic treatments to obstetrics.

While better quality care is available today, it is now delivered from a variety of professionals, each with specialized training and a different knowledge set. When layered with the maze of insurance coverages, the process is a far cry from the one-stop medical shop of the 50s. The fact is in the current United States healthcare environment, no single person, facility or plan manages patient information. It is more important than ever for the patient to take charge of his or her own health-in and out of the doctor's office.

Here are simple steps from WakeMed's program and other resources that will help you become an active, informed health care consumer:

• Be your own advocate before medical care is necessary. Gather basic knowledge about any medical conditions and the results of your most recent doctor visits. This is not to say you have to become an expert. Ask your doctor for explanations in laymen's terms and research other sources on the Internet or your local public library.
• Use a worksheet detailing all prescriptions and consider taking it with you to each doctor visit. Know why and when you take each medication, be aware of potential side effects and note if you have any allergies or negative reactions. It may also be helpful to include refill dates on the worksheet.
• Review the Evidence of Coverage (EOC) booklet for your insurance plan. Know what is covered, what is not covered, and the process where you can possibly appeal a decision rendered by the plan.
• Write out your wishes about the care you want and who can make decisions if you cannot speak for yourself. Even if you can speak for yourself, you may still wish to designate a spokesperson to help you navigate the health care process. Give copies of any forms to your doctor, family, and close friends.
• Commit to keeping all information current and in a single portfolio that is easily located by you or your spokesperson.
• If an outpatient procedure or hospitalization is recommended, ask questions and work with your doctor to decide on a treatment plan that works for you. Ask your doctor to write it down, including how long it will take before you know if your treatment is working, options in pain management, and research studies on your condition.
• Once treatment or hospitalization has started, don't be afraid to communicate. Ask if something doesn't seem right or you don't understand your care. Tell your doctor or shift nurse if you have side effects. Encourage good hand hygiene for all visitors-including your doctor and treatment team-by gently reminding everyone to wash their hands or use sanitizing gel before and after contact with you. Make sure all information on your ID band is correct and wear it at all times. Elaine Rohlik notes, "To reduce the chance of mistaken identity, at WakeMed we now ask for two identifiers that include a photo and date of birth. The patient should not be offended if the staff is constantly verifying identity through the wristbands. In fact, the patient should be leery if the staff isn't asking each time during a room visit or while receiving services." In cases of surgery, the patient may also be asked to put a self-marker on the area in need of operation.
• The discharge process is just as important as the hospital stay or the outpatient treatment itself. It can also be extremely stressful if a patient is preoccupied by thoughts of getting a ride home or assuming responsibility for his or her own care. Don't be afraid to ask questions or have your spokesperson present to take notes and recite the correct information back to the lead member of the discharge team. The hospital staff should be willing to take the appropriate time to cover any discharge instructions. Before leaving, make sure you can read the handwriting on your prescriptions. If you can't read the prescription, your pharmacist may not be able to either.